Pediatrics group warns against crib bumper pads

The American Academy of Pediatrics' new guidelines state there is no evidence that crib bumper pads prevent injuries and say they pose a potential risk of suffocation, strangulation and entrapment.

The American Academy of Pediatrics' new guidelines state there is no evidence that crib bumper pads prevent injuries and say they pose a potential risk of suffocation, strangulation and entrapment. (Michael Tercha/Chicago Tribune)

Ellen Gabler, Tribune reporter

Many parents will soon hear from their pediatricians that bumper pads should not be used in cribs because babies can suffocate against or be strangled by the popular bedding product.

The American Academy of Pediatrics set the guideline for its physicians as part of updated policies to create safer sleep environments for babies and reduce the risk of sudden infant death syndrome, or SIDS.

By stating that bumper pads should not be used, the Elk Grove Village-based academy is providing direction to members on a question still being hotly debated.

The trade group for makers and sellers of infant bedding says bumper pads, which wrap around the inside of a crib and tie to crib slats, help prevent head injuries and limb entrapment. It also disputes there is evidence that the products can cause babies to suffocate.

But the academy's new guidelines state there is no evidence that bumper pads prevent injuries and say they pose a potential risk of suffocation, strangulation and entrapment.

"We weighed the pros and cons and the evidence, and felt that the safest thing would be to keep bumpers out of the crib altogether," said Dr. Fern R. Hauck, a member of the academy's SIDS task force and a professor of family medicine at the University of Virginia.

Investigations by the Tribune this year and last year found that federal regulators with the Consumer Product Safety Commission have gotten reports for years of babies suffocating against bumper pads, yet they have failed to warn parents or investigate all the deaths.

The regulators have hesitated to take a stance on the safety of bumper pads, saying they are trying to determine if there is a scientific link between bumper pads and suffocation, or if blankets, pillows or medical issues played a primary role in the babies' deaths.

In response to the Tribune's stories, the city of Chicago and state of Maryland recently prohibited sales of crib bumpers, often packaged as part of bedding sets.

The Juvenile Products Manufacturers Association, meanwhile, launched a campaign arguing that bumpers are not a significant risk factor for infant death when used properly, while also warning parents not to use bumpers that are too puffy.

Bumpers were originally made to cover spaces between crib slats that were too far apart. Regulations changed in the 1970s, mandating that slats be spaced closely enough that babies wouldn't fall out or get their heads caught. But the products are still widely sold.

Every five years the pediatrics academy updates its official policies, which serve as a guide to pediatricians and other medical professionals throughout the country. Previously, the policies stated that if crib bumpers were used, they should be thin, firm, well secured and not "pillow-like" — a vague term that irked safe-sleep experts and SIDS groups.

"It was just confusing," said Nancy Cowles, director of Kids in Danger, a safety advocacy group. "I think this clarifies things — bare is best."

In a statement, the academy said that although the number of deaths associated with sudden infant death syndrome has declined in the last two decades, sleep-related deaths from suffocation, entrapment and asphyxia have increased.

Besides stating that bumper pads should not be used, the group also recommended that babies always sleep on a firm surface, not in car seats or other products that babies sit in. Wedges and positioners shouldn't be used, and the policies recommend breast-feeding and immunizations to reduce SIDS deaths.

Cowles and other safe-sleep experts often promote the "ABCs" of safe sleep — babies should sleep alone, on their backs and in a crib. Infants can lack the motor skills and strength to turn their heads if they roll against something that blocks their breathing.

Dr. Michael Goodstein, a member of the academy's task force and a neonatologist at York Hospital in Pennsylvania, said parents who remove bumpers from cribs should not add other soft bedding like pillows or blankets instead.

"Soft is just bad," he said.

In March, the Tribune reported that federal officials have investigated at least a dozen deaths where bumpers appeared to play a role. In those fatalities, the Consumer Product Safety Commission said bumpers were not clearly the culprit because other items were also in the crib. But in reviewing the agency's own records, the Tribune found that in many of those cases, babies who died were found with their faces pressed into bumper pads.

The Tribune also found at least 17 additional cases in which the safety agency did not investigate a child's death even though the agency had reports on file suggesting bumper pads played roles in the fatalities. The Tribune looked into some of the cases and found that medical examiners and coroners said bumper pads were involved in the suffocations.